Ask Dr. Block: Hand-Foot Syndrome

Q. What do you recommend for hand-foot syndrome from the oral chemo (for metastatic breast cancer) Xeloda, other than dose reduction?

A. Hand-foot syndrome can be difficult to manage. Standard advice for this side effect, which is seen with several drugs, include: wear loose-fitting clothing and shoes, avoid activities that put any kind of pressure on the hands and feet as well as contact with harsh chemicals used in household cleaning products, apply moisturizers several times a day (but avoid ones that contain perfumes, alcohol or glycerin), avoid hot water exposure and excessive heat, including sun exposure and saunas. Reduction in drug dose is also commonly used.

There are two alternatives that have some recent clinical studies. We sometimes counsel patients that vitamin B6 in a 200 mg dosage may be helpful for them. Vitamin B6 in dosages of 200 and 150 mg were recently studied in two randomized trials with Xeloda. One found that there was no improvement of hand-foot symptoms, while the other found that there were fewer dose reductions with B6, and fewer of the worst levels of side effects. Though this is not a strong endorsement for B6, some patients might still find the 200 mg dose helpful. Higher dose levels might not be helpful: a group that received 400 mg in one of the studies were less likely to respond to their cancer treatment. There’s no evidence, though, that smaller doses of B6 stimulate tumor growth, and this may just be an isolated observation. A case review study examined the use of oral vitamin E in dosages ranging from 100 to 400 mg, and found that several patients experienced relief with this supplement. Results from observational studies, of course, are not as reliable as those from randomized trials, but vitamin E might be another consideration.

There are also medical strategies that can be used. A recent randomized trial found some benefit from Celebrex, which makes sense, since hand-foot syndrome is in part an inflammatory reaction. This suggests that you might want to use strategies that reduce inflammation (discussed in Chapter 15 of Life Over Cancer). You could also ask your doctor if using Celebrex or steroid medication – including topical remedies – would be appropriate for you. If your doctor finally decides, though, that dose reduction is your best option, you should know that a 2011 study found no reduction – and perhaps a small increase – in survival in breast cancer patients who received dose reductions of Xeloda.